Individual ProviderEileen Marie SparksDietitian, RegisteredDietary & Nutritional Service ProvidersPractice Address4855 SW Western Ave, Beaverton, OR 97005-3460(503) 520-4853(800) 813-2000PECOS EnrollmentBased on the most recent information from CMS, provider Eileen Marie Sparks does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1467617019Provider TypeIndividualFull NameSparks, Eileen MarieCredentialRD, CDEGenderFemaleSole ProprietorYesEnumeration Date7/23/2008Last Updated12/17/2025Contact InformationPractice LocationPractice Address4855 SW Western Ave, Beaverton, OR 97005-3460Phone(503) 520-4853FaxUnlisted FaxMailing LocationMailing Address500 NE Multnomah St Ste 100, Portland, OR 97232-2031Phone(800) 813-2000Fax(855) 524-5255Provider TaxonomiesCodeDescriptionLicenseCode133V00000XPrimaryDescriptionDietitian, RegisteredDietary & Nutritional Service ProvidersLicenseLDD000457OregonCode133V00000XDescriptionDietitian, RegisteredDietary & Nutritional Service ProvidersLicenseDI60643012WashingtonProvider IdentifiersIDDescriptionIssuerID930798039DescriptionMedicaidIssuerUnlistedOregonID95832421DescriptionOtherIssuerDRIVER LICENSEOregon